Plan A - Medica Choice Passport: $6,000-0% HSA

Image

Plan A - Medica Choice Passport: $6,000-0% HSA

National network

Medica Choice Passport® is an easy-to-use plan with a large network. You can visit any doctor, clinic or facility in the network without a referral.

Plan Highlights

  • One of the largest networks in the nation
  • No referrals needed when you see network providers 
  • Nationwide network coverage when you travel

Compare Plans

You can compare this plan side-by-side with up to two other plans to see the differences between their benefits.

Compare Plans
 
 

Benefit Summary for Plan A - Medica Choice Passport: $6,000-0% HSA

Network Benefits
Overall deductible $6,000 per person/ $12,000 per family for in-network services. $7,000 per person/ $14,000 per family for out-of-network services.
Out-of-pocket limit $6,000 per person/ $12,000 per family for in-network services. $10,200 per person/ $19,400 per family for out-of-network services.
If you visit a health care provider's office or clinic
Primary care visit 0% coinsurance
Chiropractic visit 0% coinsurance
Convenience care visit 0% coinsurance
Specialist visit 0% coinsurance
Preventive care/screening/immunization No charge. Deductible does not apply.
If you have a test
Diagnostic test - lab 0% coinsurance
Diagnostic test - x-ray 0% coinsurance
Imaging (CT/PET scans, MRI) 0% coinsurance
If you need drugs to treat your illness or condition
Generic drugs Retail: 0% coinsurance Mail order: 0% coinsurance
Preferred brand drugs Retail: 0% coinsurance Mail order: 0% coinsurance
Non-preferred brand drugs Retail: 0% coinsurance Mail order: 0% coinsurance
Specialty drugs Preferred: 0% coinsurance Non-preferred: 0% coinsurance
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center) 0% coinsurance
Physician/surgeon fees 0% coinsurance
If you need immediate medical attention
Emergency room care 0% coinsurance
Emergency medical transportation 0% coinsurance
Urgent care 0% coinsurance
If you have a hospital stay
Facility fee (e.g., hospital room) 0% coinsurance
Physician/surgeon fees 0% coinsurance
Network information
Network type National network
Network area Nationwide
Special features Largest network of providers.
Referrals needed No referrals needed if you see a Medica Choice Passport network provider.

How it Works

Choose from any doctor, clinic or facility in the large Medica Choice Passport network. While you don’t need a referral to see a specialist in the network, it’s a good idea to work closely with your primary care doctor to coordinate your health care needs.

» View the Summary of Benefits and Coverage for Plan A - Medica Choice Passport: $6,000-0% HSA. 

» Find a physician or facility in Medica Choice Passport.

mymedica.com

Once your plan starts, register on mymedica.com to manage your health plan. Order ID cards, find out what's covered, track your claims and more!

Visit mymedica.com